Vulvodynia - a pain in my vulva
Vulvodynia refers to chronic vulvar pain. The vulva is the outer female genitalia including the labia, clitoris, urethral opening, vaginal opening, and anus. It is estimated that it affects 7 to 8% of women under the age of 40 (1). It can divided into three subtypes:
1. Provoked: pain with direct contact with the tissue
2. Spontaneous: no direct contact is needed, the pain can be random and appear without cause
3. Mixed
Provoked vestibulodynia (pain at the entrance of the vaginal, also known as the vestibule) is the leading cause of vulvar pain in premenopausal women (1). It is commonly described as sharp or burning pain at the entry of the vagina with direct touch (i.e. penetration) and causes pain with intercourse, speculum exams, and tampon insertion.
The cause of provoked vestibulodynia (PVD) is thought to be multifactorial with influences from inflammatory, hormonal, genetic, neurological and muscular pathways. Several studies has shown increased pelvic floor muscular tone with decreased strength, coordination and endurance in women with PVD. Clinical guidelines recommend pelvic physiotherapy to address these muscular changes (1).
Pelvic physiotherapy treatment for PVD focuses on:
· Improving muscular awareness and control
· Improving muscular relaxation
· Normalizing muscular tone
· Tissue desensitization
· Pain education
· Vulvar care education
· Bladder and bowel care education
PVD is a complex condition that is best managed by a multidisciplinary team including a gynecologist, counsellor or psychologist and pelvic physiotherapist (1) (2). If you suffer from vulvar pain or pain with tampon insertion or intercourse, do not hesitate to contact a pelvic physiotherapist to discuss your treatment options.
Sources:
1. Systematic Review of the Effectiveness of Physical Therapy Modalities in Women with Provoked Vestibulodynia. Melanie Morin, Marie-Soleil Carroll, and Sophie Bergeron. s.l. : Elsevier Inc. , 2017.
2. Vulvodynia: Assessment and Treatment. Andrew T. Goldstein, MD, Caroline F. Pukall, PhD, Candace Brown, PharmD, Sophia Bergeron, PhD, Amy Stein, DPT, and Susan Kellogg-Spadt, PhD. 2016, The Journal of Sexual Medicine, pp. 572-590.
